People with bipolar disorder are all-too-familiar with cycles – the moving from one mood to another – but not everyone knows that for some, moods can cycle ultra-ultra-rapidly. When a mood cycles last less than a day this is known as ultradian cycling. Ultradian cycling bipolar disorder is a very tough variant of bipolar disorder to treat and to live with.

About Ultradian Cycling

Please see this video below about ultradian cycling:

Ultradian Cycling Bipolar Disorder – Things to Know About Cycling and Bipolar

One thing to know about ultra-ultra-rapid cycling in bipolar disorder is that it’s very real. People with it are not “moody” per se. People with it are experiencing an illness that forces them to experience ever-shifting moods. I know what this is like. It’s real. It’s horrible. And remember, some people go through this every day.

Another thing to know is that antidepressants can cause cycling – in fact, can cause ultradian cycling – in those with bipolar disorder. This is important to know so that if you start experiencing rapid cycling after you start an antidepressant, you may want to get off of that antidepressant and see if it helps. (See here for how to get off an antidepressant while minimizing withdrawal.)

Rapid cycling variants of bipolar disorder can be harder to treat than standard bipolar disorder which has moods that last for months. This makes sense because if your mood lasts for months you really have a chance to get a handle on it and treat that specific mood. In other words, you know if you need to work things up or down because of where the mood is. If your mood is always shifting, you don’t need “up” or “down” you need level. That is much harder to target.

The spectrum from standard cycles to rapid cycles to ultra-rapid cycles to ultradian cycles is a bit arbitrary and there are no dead-set definitions for each. Plus, a person may waver between what length of cycles they have (I do that).

Rapid Cycling Bipolar Disorder in the Literature

According to Jim Phelps MD on PsychEducation.org, the following are posited after a literature review:

  • An early age of onset is associated with a greater likelihood of rapid cycling.
  • Episode frequency is a highly familial trait.
  • Two recent studies reported that variations in the gene for brain derived neurotrophic factor (BDNF) are associated with rapid cycling, but not with bipolar disorder in general.
  • In most patients, rapid cycling is a transient phenomenon; but it can persist for years in some. In general, the presence of rapid cycling is associated with greater treatment resistance. Even after it resolves, patients who have had it experience a more severe course of illness than those who did not have it.

So what have we learned? We’ve learned that rapid cycling (and certainly ultradian cycling) bipolar disorder sucks, on all levels.

Treating Ultradian Cycling Bipolar Disorder

Now, at this point, I would love to point you to some brilliant information that would address ultradian cycling using gold-standard research. Unfortunately, I can’t do that. I can’t do that because we don’t have enough research on rapid cycling in bipolar disorder to really say much that is definitive.

One thing I strongly suspect we can say, though, is that antidepressants are really bad for you if you rapid cycle. Here is an excellent case study about gradual antidepressant withdrawal and its effects on cycling. Both Gary Sachs MD, Director of the Harvard Bipolar Disorder Program, and Dr. Phelps agree on this point. (There’s more here.)

Something I strongly believe is that with rapid cycling versions of bipolar disorder you need to treat the cycling first and the mood second. I know this sounds kind of counter-intuitive but it’s not until you have a steady target (a specific mood) that you have anything to really aim for. You need to treat the cycling to get that target to sit still. Then you can start treating whatever mood symptoms are left. (This belief is based on personal experience and research, but feel free to disagree.)

One other thing to note about ultradian bipolar disorder treatment is that you might consider treating it in the same way that mixed states in bipolar disorder are treated. As I mentioned in the video above, ultra-ultra-rapid cycling moods can also be thought of as mixed moods as per the current diagnostic guidelines. Medications that are Food and Drug Administration approved to treat bipolar mixed moods are:

More on mood stabilizers can be found here.

Additionally, something unique that might work for ultradian cycling treatment is dark therapy.

Dark Therapy as Ultradian Bipolar Disorder Treatment

Most people (and even some doctors) haven’t heard of dark therapy. It’s a pretty simple concept. Dark therapy involves controlling the dark and light hours of your day. It’s not the easiest thing to do (I’ve tried it).

In this case study, darkness was enforced from 6:00 p.m. until 8:00 a.m. the next morning. That’s 14 hours — that’s a lot of darkness. But this is critical because what you’re trying to do is reset your internal clock (circadian rhythm) and you kind of have to hit it with a baseball bat at first to get it to change. (You’ll note in the case study that after a few weeks it was lessened to 10 hours of enforced darkness per day.)

Unfortunately, there is very little research on dark therapy. Personally, I think if ultradian bipolar disorder is wreaking havoc on your life, it’s well worth trying (with your doctor’s say-so), but that’s just my opinion.

What anyone with bipolar disorder (rapid cycling or no) can take away from this, though, is that dark and light are very important in bipolar disorder and contribute to sleep cycles as well as mood cycles. For this reason, at the very least, you should be controlling your blue light intake in the evenings. (See here for more on light and darkness in bipolar disorder.)

Ultradian Bipolar Disorder Is Real – And Treatable

Just like with all versions of bipolar disorder, some people are going to be more successfully treated than others, that’s just the unfair fact of it. That said, ultradian bipolar disorder is treatable.

So if you’re suffering with moods that only last for hours, don’t give up and make sure and be open with your doctor about it. And if you need to, bring your doctor information about the above to help with your treatment. You can do this.

(While you’re here, you may also want to read something I wrote a few years ago: Dealing with Rapid Cycling Bipolar Moods in Everyday Life.)

Banner image by Giorgiogp2 [CC BY-SA 3.0 or GFDL], from Wikimedia Commons.

Image by Flickr user GalgenTX.